FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
`
`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`
`
`
`Index No.: 161626/2023
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`
`AFFIDAVIT IN SUPPORT
`
`
`
`
`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF NEW YORK
`-------------------------------------------------------------------------X
`SEQUAN MARTIN
`TYRONE PEART
`
` The “Individual Defendants”
`
` -and-
`
`ABU MUHAMMAD M HAQUE MD, PC,
`ACE EMERGENT MEDICAL CARE PC,
`ACTIVE LIFE CHIROPRACTIC, PC,
`ADVANCED HEALING, INC,
`AMBULATORY SURGERY CENTER OF BROOKLYN,
`LLC,
`AR REHAB PT PC,
`BEACH MEDICAL REHABILITATION, PC,
`BSD OS LLC,
`
`CADS ANESTHESIA SERVICES PLLC,
`CHESTER MEDICAL SERVICE PC,
`COMPLETE NEUROPSYCHOLOGY, P.C. D/B/A
`PSYCHOLOGY 21 PC,
`DARA KHATIB MD,
`DAVID CARMILI PHYSICIAN, PC,
`DULEX PHARMACY INC, d/b/a ABC DRUGS,
`ELECTROMEG SUPPLY CORP,
`
`ETMC PHARMACY, INC,
`FIRST STOP PT, PC,
`FIVE STAR PHARMACY, INC,
`FIVE TOWNS PHYSICIANS PC,
`GLENN H. WHITNEY DC, PC,
`GLOBAL VERSUS INC,
`HEALTH HEAVEN SERVICES, INC,
`HEALTHY ELITE, INC,
`INTEGRATED MEDICAL REHABILITATION &
`DIAGNOSTICS, PC,
`JAMAICA HOSP ER DEPT,
`JAMAICA HOSPITAL MEDICAL CENTER,
`JHMC HOSP CO BETZ MITCHELL,
`JPRL, INC,
`
`KUMAN MEDICAL SUPPLY INC,
`LENOX HILL RADIOLOGY AND MEDICAL IMAGING
`ASSOCIATES, PC d/b/a LENOX HILL RADIOLOGY
`MEDICAL IMAGING,
`
`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
`
`RECEIVED NYSCEF: 03/01/2024
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`LIJ MEDICAL CENTER a/k/a LONG ISLAND JEWISH
`MEDICAL CENTER a/k/a NSLIJ LONG ISLAND
`JEWISH,
`LOCAS PHARMACY INC,
`LONGEVITY MEDICAL SUPPLY INC,
`NORTH SHORE-LIJ MEDICAL, PC,
`NORTH SHORE UNIVERSITY HOSPITAL,
`PARS MEDICAL, PC,
`RIGHT CHOICE PHARMACY, INC,
`ROSE CHIROPRACTIC HEALTH & WELLNESS PC,
`SCOB, LLC, a/k/a SURGICARE OF BROOKLYN,
`SKYLINE BK, INC,
`SMART INSPIRE PHYSICAL THERAPY, PC,
`STAR MEDICAL DIAGNOSTIC, PC,
`
`STAY WELL CHIROPRACTIC, PC,
`
`SUNFARM ENTERPRISES INC,
`SUPPLY CHOICE NYC INC,
`THE AMBULATORY SURGICAL CENTER OF EAST
`TREMONT MEDICAL CENTER a/k/a EAST
`TREMONT AMBULATORY SURGICAL CENTER
`a/k/a UPTOWN HEALTH CARE MANAGEMENT, INC
`a/k/a EAST TREMONT MEDICAL CENTER
`THE JAMAICA HOSPITAL,
`TOPAZ V INC,
`TOWN RX, INC,
`TRI- BOROUGH NY MEDICAL PRACTICE, PC, a/k/a
`BRONX MEDICAL,
`WALTON MEDICAL PLAZA PC,
`
` The “Medical Provider Defendants”.
`-------------------------------------------------------------------------X
`
`STATE OF NEW YORK
`
`
`
`
`COUNTY OF QUEENS
`
`
`
`
`JORONDA MCBURNIE being duly sworn, deposes and says the following:
`
`1.
`
`I am employed by HEREFORD Insurance Company (hereinafter “HEREFORD”),
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`and I have been employed as such for all times pertinent to this statement. I am currently employed
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`as the No-Fault Claims Supervisor. Prior to that, I was employed as a Senior No-Fault Adjuster.
`
`
`
`)
`)
`)
`
`ss:
`
`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`2.
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`I was the adjuster assigned to claim number 103844, and as such I am familiar with
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`the facts of the instant action based upon my personal handling and review of the claim file.
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`3.
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`As both a Senior No-Fault adjuster and the No-Fault Claims Supervisor, my duties
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`include the identification of fraud indicators in accident reports and claim submissions, reviewing
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`and investigation of claims, conducting and attending EUOs and IMEs of insured owners, drivers,
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`and No-Fault claimants, opening and maintaining SIU cases after review of accident reports,
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`claimants’ alleged injuries, and medical facilities where claimants are treating, and determining if
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`the claims are covered events.
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`4.
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`Once I have fully reviewed and investigated a claim file, I make a determination
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`regarding whether or not the collision was a staged event, whether fraud was involved in any aspect
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`of the claim, whether or not the collision was an insurable event, and whether or not the injuries
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`alleged by the Claimants are causally related to the underlying collision.
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`5.
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`All of my duties are circumscribed by the protocols, customs, and practices required
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`by HEREFORD, of which I am fully familiar and abiding.
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`6.
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`16.
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`I submit this affidavit in support of HEREFORD’s Motion for Summary Judgment.
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`In this action, HEREFORD seeks a declaration that it has no obligation to provide
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`coverage to the Defendants relating to the alleged May 28, 2023, collision, under HEREFORD
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`claim number 103844 involving TYRONE PEART (“PEART”) and SEQUAN MARTIN’s
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`(“MARTIN”, referred to collectively with PEART as “Claimants”).
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`INSURANCE POLICY INFORMATION AND MOTOR VEHICLE INCIDENT
`
`17.
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`HEREFORD claim number 103844 involves an alleged automobile incident, which
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`reportedly occurred on May 28, 2023 (the “subject loss”).
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`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`18.
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`HEREFORD received multiple Police Reports for the subject loss. According to
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`the first Police Report (the “1st Report”), at the time of the alleged loss, non-party Mohammad
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`Hossain (“Hossain”) was driving a 2017 Toyota livery vehicle (the “insured vehicle”), registered
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`to and insured by Sayeda Family Corp, when the insured vehicle was rear-ended by an adverse
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`vehicle on the Van Wyck Expressway in Queens, New York. The adverse vehicle then fled the
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`scene without exchanging information or awaiting police arrival. According to the 1st Report, in
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`MARTIN was the only passenger in the insured vehicle at the time of the loss. The 1st Report states
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`one person injured but does not list any injuries for MARTIN or Hossain and does not state that
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`either party requested or received any medical attention at the scene. See Police Reports, annexed
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`hereto as Exhibit “F”.
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`19.
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`HEREFORD received a second Police Report (the “2nd Report”). The 2nd Report
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`states that MARTIN was also in the vehicle at the time of the loss and was taken to the hospital
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`prior to police arrival. The 2nd Report states that two people were injured but does not list any
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`injuries or identify who was injured. See Police Reports, annexed hereto as Exhibit “F”.
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`7.
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`Claimants later alleged to have sustained significant bodily injuries as a result of
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`the collision, and HEREFORD assigned claim number 103844 to all No-Fault claims relating to
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`the subject loss. See Claimants’ Applications for No-Fault Benefits (“NF-2s”) and letters of
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`representation, annexed as Exhibit “G”.
`
`8.
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`Claimants began receiving extensive medical treatments from, inter alia, ABU
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`MUHAMMAD M HAQUE MD, PC; ACE EMERGENT MEDICAL CARE PC; ADVANCED
`
`HEALING, INC; AMBULATORY SURGERY CENTER OF BROOKLYN, LLC; AR REHAB
`
`PT PC; BEACH MEDICAL REHABILITATION, PC; BSD OS LLC; CADS ANESTHESIA
`
`SERVICES
`
`PLLC;
`
`CHESTER MEDICAL
`
`SERVICE
`
`PC;
`
`COMPLETE
`
`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`NEUROPSYCHOLOGY, P.C. D/B/A PSYCHOLOGY 21 PC; DARA KHATIB MD; DULEX
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`PHARMACY INC D/B/A ABC DRUGS; ELECTROMEG SUPPLY CORP; FIRST STOP PT,
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`PC; FIVE TOWNS PHYSICIANS PC; GLOBAL VERSUS INC; JPRL, INC; LENOX HILL
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`RADIOLOGY AND MEDICAL IMAGING ASSOCIATES, PC D/B/A LENOX HILL
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`RADIOLOGY MEDICAL
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`IMAGING; RIGHT CHOICE PHARMACY,
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`INC; ROSE
`
`CHIROPRACTIC HEALTH & WELLNESS PC; STAR MEDICAL DIAGNOSTIC, PC; STAY
`
`WELL CHIROPRACTIC, PC; SUNFARM ENTERPRISES INC; SUPPLY CHOICE NYC INC;
`
`TOPAZ V INC; and WALTON MEDICAL PLAZA PC (the “Medical Provider Defendants”).
`
`9.
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`HEREFORD assigned claim number 103844 to the May 28, 2023, loss involving
`
`the Claimants. As there were multiple claimants reporting injuries for the loss, HEREFORD
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`assigned the -03 suffix to claim number 103844 for all claims of PEART, and -06 to the claims of
`
`MARTIN.
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`10.
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`Prior to May 28, 2023, HEREFORD issued a “New York For Hire” automobile
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`insurance policy number CA310695 (the “Policy”) to non-party Sayeda Family Corp for a
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`HEREFORD insured livery vehicle (the “insured vehicle”), covering any occupants of the insured
`
`vehicle for any medically necessary and causally related medical expenses suffered arising out of
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`the use or operation of the insured vehicle as a result of an accidental collision or any other person
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`who sustains personal injury arising out of the use or operation of the insured vehicle in New York
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`State. The Policy also includes uninsured, supplementary uninsured, underinsured, and liability
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`coverage.
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`11.
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`The HEREFORD vehicle was in New York at the time of the loss and insured under
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`a New York State motor vehicle policy of insurance. Therefore, the New York No-Fault regulation
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`applies.
`
`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`12.
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`The Claimants and the Medical Provider Defendants, acting as the assignees of the
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`Claimants, have sought to obtain the applicable coverage under the Policy and its endorsements
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`and/or under the New York State No-Fault Regulation.
`
`HEREFORD’S REASONABLE BASIS FOR REQUESTING EUOS OF THE CLAIMANTS
`
`20.
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`The circumstances surrounding the alleged May 28, 2023, collision raised a strong
`
`possibility that the collision did not occur as the Claimants alleged and/or that the Claimants’
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`alleged injuries and any subsequent treatment by the Medical Provider Defendants were not
`
`causally related to the alleged May 28, 2023, collision, both of which would be considered non-
`
`covered events under the No-Fault Regulation and the Policy.
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`21.
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`Upon receiving notice of the accident, Plaintiff began an investigation As part of
`
`its investigation, HEREFORD obtained a sworn statement from Hossain, which stated the impact
`
`was not hard, there was no damage to the insured vehicle, and that he does not believe either
`
`passenger was injured. See Driver’s Affirmation, annexed as Exhibit “H”.
`
`22.
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`HEREFORD had, and continues to have, a reasonable basis to request the EUO of
`
`the Claimant and because, in addition to the sheer magnitude of the claims submitted, the claim’s
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`legitimacy was questionable because the injuries appeared to be exaggerated compared to the
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`severity of the alleged accident. Specifically,
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`23.
`
`24.
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`That there were different Police Reports for the alleged loss.
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`The loss involved a hit and run vehicle, which fled the scene. This is a common
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`pattern in staged losses investigated by HEREFORD.
`
`a. MARTIN did not request or receive medical treatment at the scene, yet thereafter
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`claimed extensive injuries.
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`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`b. There was no damage to the insured vehicle as a result of the loss, yet the Claimants
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`were receiving excessive and boiler-plate No-Fault treatment.
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`c. The driver of the insured vehicle was not claiming injuries, only the Claimants.
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`d. Claimants began treating at a medical facility that HEREFORD is/was investigation
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`for concerns regarding billing practices and ownership and control of said entity.
`
`25.
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`Based on these facts, HEREFORD, pursuant to its rights under the No-Fault
`
`Regulation, requested the Claimants submit to EUOs in order to:
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`a. Verify and confirm the true facts and circumstances surrounding the May 28, 2023,
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`loss;
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`b. Verify the alleged medical treatment and services allegedly provided, as the
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`collision was minor in nature, yet the Claimants were making extensive claims of
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`injury;
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`c. verify whether the incident was covered under the HEREFORD policy of
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`insurance; and
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`d. determine whether the Claimants were eligible to collect No-Fault benefits pursuant
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`to 11 N.Y.C.R.R. § 65-3.16(a)(12) and Insurance Law 3102(a)(1).
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`26.
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`As such, HEREFORD assigned counsel, Goldberg, Miller & Rubin, PC (“GMR”)
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`to conduct the Claimants’ EUOs.
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`EUO OF CLAIMANTS
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`1.
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`On August 24, 2023, HEREFORD received a bill from Defendant ACTIVE LIFE
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`CHIROPRACTIC, for a diagnostic ultrasound (CPT code 76999) rendered to PEART on August
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`24, 2024. On August 29, 2023, HEREFORD received a bill from Defendant Staywell Chiropractic
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`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`for a diagnostic ultrasound (CPT code 76999) administered to MARTIN on Juny 29, 2023. See
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`bill, annexed hereto as Exhibit “H”.
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`2.
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`Claimants appeared for their EUOs. However, their testimony raised additional
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`issues as to the legitimacy of the accident and medical necessity of the purported medical
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`treatments, which further contributed to a strong possibility that the Claimants’ submitted
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`treatments were not causally related to the alleged collision, were exaggerated, and/or did not arise
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`from an insured incident.
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`3.
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`In particular:
`
`
`
`
`
`
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`a. Each Claimant testified to not receiving significant portions of the medical
`records billed to HEREFORD.
`
`
`
`
`
`
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`i. PEART admitted that he did not understand the paperwork he signed at the
`clinic and that no one was there to assist him.1
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`ii. PEART testified to not receiving the results of multiple medical tests
`administered to him.2
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`iii. MARTIN is scheduled for right knee surgery, but does not know the issue
`with his knee, the surgeon, or where he would go to have the surgery done.3
`
`iv. MARTIN could not recall receiving the results of at least two sets of tests
`that were administered to him.4
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`v. MARTIN denied receipt of several items of medical equipment, for which
`HEREFORD received billing for.5
`
`b. Claimants provided conflicting and convoluted timelines for the periods
`immediately before and after the accident, evidencing that their sole purpose for
`hiring the HEREFORD taxi was to stage this accident:
`
`
`
`i. Claimants both testified that they arrived together to a club together prior to
`ordering a ride with the insured vehicle. However, PEART testified they
`
`
`1 See PEART EUO Transcript, annexed as Exhibit “J”, pg. 45-46.
`2 Exhibit “J”, pg. 54-55 (nerve testing); pg. 58, lns 11-21 (CT scan); pg. 61-62 (ultrasound).
`3 See MARTIN EUO Transcript, annexed as Exhibit “K”, pg. 58-60.
`4 Exhibit “K”, pg. 60-62.
`5 Exhibit “K”, pg. 63-64.
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`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`were at the club for “[p]robably two and a half to three hours”6 while
`MARTIN testified that they only stayed “[a]bout 20, 30 minutes.”7
`
`ii. Based on MARTIN’s timeline, Claimants did not meet until around 4:00
`am or 4:30am and the accident occurred within 30 minutes of their
`meeting.8
`
`c. Both Claimants testified that from the impact to the rear of the HEREFORD
`vehicle they were flung forward in contradiction to physical laws.9
`
`
`d. Each claimant described choosing their respective medical treatment location
`independently of one another.10 Yet, each treated with five of the same medical
`providers. Exhibit “E”.
`
`
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`27.
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`Based on its investigation into the collision and Claimants’ EUO testimony,
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`HEREFORD maintains a founded belief that the Claimants’ alleged injuries and any subsequent
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`No-Fault treatment submitted by the Medical Provider Defendants was not causally related to the
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`May 28, 2023, collision and/or not actually provided, and has denied the Medical Provider
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`Defendants’ claims on this basis.
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`MARTIN FAILED TO RETURN A SUBSCRIBED TRANSCRIPT
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`28.
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`After MARTIN’s EUO, by letter dated November 13, 2023, HEREFORD
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`forwarded MARTIN and his attorney, Pollack, Pollack, Isaac & Decicco, a copy of MARTIN’s
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`EUO transcript along with a request to subscribe to same. The request also informed MARTIN’s
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`and his counsel that per the No-Fault regulation, MARTIN required to subscribe said transcript
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`and failure to do so could result in denial of coverage. See Subscription Requests, annexed as
`
`Exhibit “L”.
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`29.
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`HEREFORD did not receive a response to this request.
`
`
`
`6 Exhibit “J”, pg. 31-32.
`7 Exhibit “K”, pg. 22, lns 15-18.
`8 Exhibit “K”, pg. 23-24
`9 Exhibit “J”, pg. 21-22; and Exhibit “K”, pg. 14, lns 13-19.
`10 Exhibit “J”, pg. 43-44; and Exhibit “K”, pg. 34-35.
`
`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`30.
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`Accordingly, by letter dated December 13, 2023, HEREFORD sent a follow-up
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`request toto subscribe to MARTIN and his counsel.
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`31.
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`HEREFORD did not receive a response to this request.
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`32. MARTIN failed to execute and return his transcript to HEREFORD, breaching a
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`condition precedent to coverage. HEREFORD denied Medical Provider Defendants’ claims on
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`this basis.
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`33.
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`All of the notices sent from HEREFORD were prepared and sent in the ordinary
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`course of business utilizing the standard practices and procedures within HEREFORD for
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`generation and mailing of same.
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`34.
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`Based on the above and its investigation into the collision, and the Claimants’
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`violations of the No-Fault Regulation and applicable policy, HEREFORD is entitled to default
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`judgment on the causes of action in its complaint, declaring it has no obligation to pay the
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`Defaulting Defendants’ claims, including any and all No-Fault claims; any and all uninsured,
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`underinsured, supplementary-uninsured, or supplementary-underinsured motorist-benefit claims;
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`any and all medical-payment claims; any and all property-damage claims; and any and all bodily-
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`injury-liability benefits under the Policy arising from the May 28, 2023 collision under claim
`
`number 103844-03 and 103844-06.
`
`
`
`
`
`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
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`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`35.
`
`As such, this affidavit is respectfully submitted in support of HEREFORD’s Motion
`
`______________________________
`Joronda McBurnie
`
`for Default Judgment.
`
`
`
`
`
`
`
`
`
`Sworn to before me this __ day
`of _______________, 2024
`
`_____________________________
`Notary Public
`
`Harlan R. Schreiber
`Notary Public, State of New York
`No. 02SC0001438
`Qualified in New York County
`Commission Expires February 13, 2027
`
`
`23
`
`February
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`

`

`FILED: NEW YORK COUNTY CLERK 03/01/2024 03:19 PM
`NYSCEF DOC. NO. 87
`
`INDEX NO. 161626/2023
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`RECEIVED NYSCEF: 03/01/2024
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`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF NEW YORK
`-----------------------------------------------------------------X
`HEREFORD INSURANCE COMPANY,
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`
`
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`
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`Plaintiff,
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`Index No.: 161626/2023
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`WORD COUNT
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`CERTIFICATTION
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`-against-
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`
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`SEQUAN MARTIN
`TYRONE PEART
`
` The “Individual Defendants”
`
` -and-
`
`ABU MUHAMMAD M HAQUE MD, PC, et. al.
` The “Medical Provider Defendants”.
`-----------------------------------------------------------------------------X
`
`Pursuant to Section 202.8-b of the Uniform Rules of the Supreme and County Courts, the
`undersigned, an attorney admitted to practice law in the State of New York, hereby certifies that
`the affidavit of Joronda McBurnie dated February 23, 2024 was prepared on a computer in 12-
`point Times New Roman font, is double spaced and contains 2504 words, a number generated by
`the word-processing system used to generate the document, Microsoft Word, and relied upon in
`preparing this certification. I further certify that the document complies with the word count limit
`as established by Section 202.8-b.
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`_______________________________
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`Zachary Whiting, Esq.
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`Dated: March 1, 2024
` New York, New York
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